The Division would like to provide notice that the Commissioner has adopted the following amended and new regulations:
The purpose of this regulation is to establish the requirements, process, and form to be utilized by carriers, contracted pharmacy benefit management firms, and private utilization firms for the prior authorization process for prescription drug benefits.
This regulation is being amended to add in requirements from House Bill 24-1149.
The purpose of this regulation is to establish the requirements for a carrier payment dispute arbitration program; to ensure that out-of-network providers seeking arbitration concerning payment received from a carrier utilize a standard arbitration request form; and to establish qualification requirements for arbitrators who participate in this arbitration program.
This regulation is being amended to make updates to the arbitration request timelines and fee requirements.
The purpose of this regulation is to provide reporting templates for carriers to use in completing and posting on their public facing websites the required disclosure of prior authorization requests and exemptions pursuant to § 10-16-112.5 (2)(c)(I) and (2)(c)(IV), C.R.S. and prior authorization requirements applicable to the prescription drug formulary for each health benefit plan pursuant to § 10-16-124.5(3.5)(a), C.R.S.
The purpose of this regulation is to require carriers offering health benefit plans to attest to the Commissioner compliance with annual reviews and reporting requirements in §§ 10-16-112.5 and 10-16-124.5, C.R.S.
These regulations will become effective March 30, 2025.
Regulations that have been adopted, but are not yet effective can be found on the Division's website.